My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
80-449
EnvironmentalHealth
>
EHD Program Facility Records by Street Name
>
C
>
CHEROKEE
>
25679
>
4200/4300 - Liquid Waste/Water Well Permits
>
80-449
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
7/4/2019 10:45:16 PM
Creation date
12/4/2017 5:30:03 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
80-449
STREET_NUMBER
25679
Direction
N
STREET_NAME
CHEROKEE
SITE_LOCATION
25679 N CHEROKEE
RECEIVED_DATE
07/01/1980
P_LOCATION
EDRIS E DODD
Supplemental fields
FilePath
\MIGRATIONS\C\CHEROKEE\25679\80-449.PDF
QuestysFileName
80-449
QuestysRecordID
1687275
QuestysRecordType
12
Tags
EHD - Public
There are no annotations on this page.
Document management portal powered by Laserfiche WebLink 9 © 1998-2015
Laserfiche.
All rights reserved.
/
2
PDF
Print
Pages to print
Enter page numbers and/or page ranges separated by commas. For example, 1,3,5-12.
After downloading, print the document using a PDF reader (e.g. Adobe Reader).
View images
View plain text
_ Applications Will Be Processed When Submitted Properly Completed. Be Sure To Sign The Application. <br /> `- APPLICATION <br /> t� (For Non-Transferable, Revocable, and Suspendable) <br /> ENVIRONMENTAL HEALTH PERMIT SEPTAGE <br /> LIQUID WASTE <br /> Application i ,ereb_y made to carryon business in the jurisdictional area of the San Joaquin Local Health District <br /> ,„Business Name {DBA Address f / F 7 <br /> iOwner s ' Addresses'^�'— – <br /> Firm Partners, Addresses and Telephone Numbers <br /> aBusiness Telephone No. Emergency Telephone No. <br /> Contractor Licence No. z7 – d <br /> L Applicants Name (Print) Titip, Date <br /> Please check Applicable Category (1-7) and Fill in t e Requ ed Information .� <br /> 1. ❑ PUMPER VEHICLE PERMIT REGISTRATION (FOR EACH VEHICLE) -lit <br /> For July 1, June 30, 19 Disposal Sites _. <br /> Description(Make/Yr., Color) – <br /> Serial No. CAL. License No. CAL.. Liccnse Renewal No. <br /> Capacity Gal., Weights & Measures No, <br /> Equipment Parking Address <br /> 2. ❑ PUMPER YARD <br /> For July 1, June 30, 19 <br /> No. of Vehicles Stored <br /> No. of Chemical Toilets Stored <br /> 3. ❑ PERCOLATION TEST <br /> R.S. or R.C.E. Name R.S. or R.C.E. No. <br /> Test L ation Test Date/Time <br /> 4. SANITATION PERMIT <br /> Job Address/ ation --6 211" e– <br /> �Ow r Address <br /> PTIC TANK ❑ CESSPOOL ,M I HING FIELD SEEPAGE PIT ❑ PACKAGE PLANT <br /> I� PERMANENT ❑ TEMPORARY Lj NEW ❑ REPAIR ❑ OTHER C <br /> 5. ❑ CHEMiCAL TOILETS For July 1, -June 30, 19 +►� <br /> Type Construction Disposal Site <br /> No. of Units Equipment Storage/Cleaning Location(s) <br /> 6. ❑ PACKAGE TREATMENT PLANT For July 1, -June 30, 19 <br /> Operator Name Where Certified <br /> Plant Location <br /> Plant Capacity No. Units Served X <br /> 7. ❑ LAUNDRY For July 1, -June 30, 19 <br /> SIZE: ❑ Less Than 1,000 Sq. Ft., ❑ More Than 1,000 Sq. Ft. A <br /> ❑ DRY CLEANING, Chemicals Used/Amount/Mo. <br /> r <br /> I hereby certify that I have prepare this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, state laws, and rule of regulations off the Joaquin Local Health District. <br /> APPLICANT'S SIGNATURE X <br /> FOR DEPARTMENT USE ONLY <br /> Fee Is Dile: ❑ ANNUALLY ❑ PER UNIT ❑ PER SITE ❑ EACH ❑ January 1 &Received By January 31 ❑ July 1 &Received By July 31 <br /> REMIT <br /> BILLING REMITTANCE $ <br /> BASE EXPLANATION DATE DATE REMITTED AMOUNT DUE CHECKED <br /> AMOUNT <br /> FEE <br /> LESS f _ <br /> PRORATION <br /> PLUS <br /> PENALTY <br /> OTHER <br /> OTHER <br /> Received by Date Receipt No. Permit No. Issuance Date' Mailed Delivered <br /> APPLICANT—RETURN ALL COPIES TO: ENVIRONMENTAL HEALTH PERMIT/SERVICES 1601 E.HAIELTON AVE.,P.O.Boz 2009 STOCKTON,CA <br />
The URL can be used to link to this page
Your browser does not support the video tag.